Student Services - Housing Agreement
ATTENTION: Housing Coordinator
1200 North Elm Street, Greensboro, NC 27401
Phone: (336) 832-8025

As part of the clinical rotation in the Piedmont AHEC region, state funding has been allocated to provide housing accommodations at various locations within the area. The housing is provided at a significantly subsidized cost to enrich your student experience during your clinical community-based curriculum as determined and controlled by the curriculum of your faculty and institution where you are enrolled. This housing is to support you in your training and encourage you to better understand the community where you are working as a potential future employment site upon your graduation. Provisions vary by location. For details, directions, and community information, visit our website, During the rotation, it is the responsibility of the student to keep the housing in good order. The following guidelines must be understood and adhered to. Please complete and click the Submit button at the bottom of the form. Thank you for being so interested.
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    Please designate the beginning rotation date.
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    Please designate the ending rotation date.
  • Include your full name.
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  • Prior to Departure:

  • Please Note:

    Violating any of the above may deny future Piedmont AHEC Housing requests and forfeit the $50 security deposit. I acknowledge that any broken rule dictates that I must vacate housing immediately. Course Coordinators will be notified of all infractions. I have read, understand and will comply with all of the above. Further, I understand that housing will not be provided unless I have signed this agreement.
  • Please provide your email if you wish to receive confirmation of this submission.